About 15,000 people in the Tulsa area with Aetna Medicare Advantage or employer coverage have been out of network at Hillcrest HealthCare System since Nov. 1, when the two sides’ agreement expired without a replacement. As of Nov. 7, no new contract has been announced. Hillcrest and Aetna each say they remain willing to keep talking.
The out-of-network status covers Hillcrest, its facilities and its employed providers, and it applies to Aetna’s Medicare Advantage plans along with its employer-sponsored commercial plans. Aetna Better Health, the company’s Medicaid plan, is not affected. That makes the split inside Aetna’s Oklahoma membership important: retirees on a Medicare Advantage plan are in the group that lost Hillcrest.
What Hillcrest and Aetna are each saying
Hillcrest’s own notice, updated Nov. 1, says the Aetna agreement was set to expire that day and no new deal was reached. “Hillcrest is now out of network with all Aetna insurance plans,” the page states. Hillcrest argues that Aetna reimburses it at rates well below market averages and points to payment delays and denied claims for care already provided…